Tag Archives: travel nursing

The Dark Side of Travel Nursing

So, I have been doing travel nursing again for essentially the past year. It has been mostly awesome. I spent 9 months in Houston, Texas, and most recently have come to St. Louis, MO. I have loved it. I have loved the freedom of working a contract and being able to take time off if needed, I have loved exploring new cities and meeting new people. It has been overall a wonderful experience!

Most recently (as in last week) though, the dark side of travel nursing reared it’s ugly head. Insecurity. Lack of benefits. No safety net. I had a “health incident”, which landed me in the hospital, on the other side of the rail so to speak. My shift started out as they usually do, getting report and developing my plan for the night. Midway through my shift though, I was having really bad chest pain. I had been feeling badly most of the week, increased heart palpitations, massive fluid retention, heartburn and fatigue. I had been chalking it up to overworking as I had been fairly consistently putting in 60+ hours per week for a while. As I stood there talking to the NP about my patient, I kept rubbing my chest unconsciously. She noticed and asked me about it, and proceeded to march me into an empty room. I took my blood pressure which prompted and “Oh my god Sarah, is that your pressure!?”. Needless to say it was a bit high. The long and short of it was, without me even being aware of it, she orchestrated someone to come in and take my patients and send me to the ER. I was furiously charting trying to catch up and they even snapped a photo of me with oxygen on refusing to get in the wheelchair until my assessment was completed.

I went to the ER, and went through the whole shebang. Because I have lupus, and I have been off my meds for 3 months, everyone started jumping up and down that I need to be admitted. Needless to say I was non-plussed. The first thing I thought of was “I can’t miss any work”. See, the dark side of travel nursing is, if you don’t work you don’t get paid. Additionally, if you opt for their housing, you can face penalties for missing your hours to supplement their expenses at maintaining your apartment. It is a very scary prospect to be a patient in the hospital, and even more so when you are facing financial issues to boot. After much foot dragging and arguing, I agreed to be admitted (have I mentioned I am a HORRIBLE patient?). My cardiac enzymes were negative, but based on my symptoms and my lupus, the doctors felt strongly that I needed a dobutamine stress echo. I will spare you the gory details, but suffice it to say, that was one of the worst experiences of my life. Nobody should ever have their heart go from 56 beats per minute to 176 beats per minute in the span of 2 minutes. I thought I was going to die. I cried.  A lot. And almost vomited on the tech, poor thing. By the time I got back up to my room, my blood pressure was so dangerously low I almost fainted in the wheelchair. Scared the poor CNA to death, but somehow managed to levitate my ass to the bed before collapsing. My blood pressure never came up to normal, and continued to be very abnormally low. I requested enzymes with my PM labs, because I truly felt like I had been having a heart attack during the stress test.

Needless to say, my stress echo was “abnormal”, much to the surprise of everyone. The cardiologists honestly thought they were just going through the paces and I would go home that day. I did not go home. They scheduled me for cardiac cath the following day, which absolutely terrified me. See, the problem with being a nurse, is you know too much. On one of my travel assignments , I sent a lovely lady to cath lab, and she never came back. I get report and transfer of all the patients with “complications” post cath. Scares the bejesus out of me. Later that night, about 1am, doctors came tiptoing in (always right when I need to go to the bathroom, like toddlers or cats), and went “ah well, tell us more about what happened during your stress test”. Suddenly everyone was interested to hear what I had tried to tell them before. Turned out I had a small MI during the test. By this point,  I felt like they were trying to kill me, to be honest. My enzymes had been negative up to that point, but their test suddenly has everyone going “um don’t get out of bed and here is a heparin drip”.  Through all of this though, my amazing friends and coworkers really saved the day. From listening to me freak out, visiting me at night when I couldn’t sleep, to making sure I was with the best interventional cardiologist for my cath, these nurses saved me. See, they didn’t see “a traveler”. They saw a fellow nurse, scared to death, and took care of me. Even my boss, went to cath lab to make sure everyone knew I worked there, came to see me, and hugged me when I was losing my shit before going to cath lab. All I wanted to do was go home….but these people kept me sane.

The next day I went for my cath. I asked for a radial approach, to have faster healing time. The cardiologist didn’t want to do it because of my Reynaud’s, but he did anyways (I begged). Turned out he was right and I should have listened to him, it hurt like a son of a bitch and still does. The long and the short of it was I apparently had a 68% blockage midway down my LAD. the put a stent in, and now I am on plavix and aspirin, with the lovely diagnosis of Coronary Artery Disease and Non Stemi Myocardial Infarction. There are no other lesions anywhere, and most likely the pain I have been having for a long, long time has been vasospasms. See, I never paid attention to my “chest pain” because it wasn’t like what I thought of as chest pain. I could point to where it hurt. Apparently that spotI could point to was halfway down my LAD. The doctor said it was a little hidden, but that I was extremely lucky considering this was in the main artery of my heart.

All of this has been overwhelming to say the least. I can’t wrap my head around the idea that at 44, with no family history, normal blood pressure, perfect cholesterol that I am a cardiac patient. Yes I am fat- have always been so. But being fat in and of itself doesn’t clog your arteries. Turns out, the pesky Lupus does. For some unknown reasons, the near constant inflammation I experience from my Lupus is worse on my arteries then having bad cholesterol. This coupled with chronic arterial vasospasms led to me needing a stent. It is possible the “benign” heart arrhythmia I have had all these years was in fact this lesion developing. Being off the meds that reduce inflammation levels in my blood exacerbated all of this. Luckily, statins also help with inflammation, also for unknown reasons. So if I take my meds like a good girl I should be fine. Mind you, I stopped them because they were making me fat. Because we live in a society where it is better to be dead than fat. That is a blog post for another day, however.

They say that experiencing a profound health crisis changes you. I don’t know that it has changed me per se, but it is definitely giving me pause to rethink things. While I love travel nursing, it is a bit like playing Russian Roulette. Unless you are smart and have 6 months of salary saved up (and face it, who among us does?), you run the risk of losing everything if you can’t work. There is no safety, no backup, no net. None of us are immune, no matter how indestructible we think we are. This experience has taught me that it is ok to be a little selfish. To think about my needs first before others. I need to get back to classes and finish school (I am going for my RN to MSN, then NP). I need to have a less stressful job. I need to make more money so I can work smarter instead of harder. The days of “well I will just pick up an extra shift” as the answer to all the financial woes must stop. I cannot be this workhorse anymore. I need some safety and security in my life, as much as is possible in this crazy world to have.

I also realized I have been afraid to share what has been going on, because of the stigma associated with CAD. I know, that people assume by looking at me that I “ate myself” into a heart attack. I also know that the people who love and care for me know that is not true. I probably have better eating habits than most of the people I know. I avoid meat, fat, eat lots of veggies etc. I loathe cheeseburgers and mayo, and usually get chased after to eat something. Obesity is a complicated thing, and not easy to deal with. I had been losing weight fairly consistently after getting off the steroids, until the new Lupus meds- then over 9 months I gained 45 pounds back.  No matter what I did, how I restricted my diet, what exercise I did, I gained. According to my fitbit  I would hit my 10K steps in the first 4 hours of work.  I gained in weird places, not normal to me. So I went off my meds. In my mind, I could be ouchy and fat, or ouchy with Lupus, what was the difference? What I didn’t stop to think about was the hidden effect the Lupus was having on my body. The insidious inflammation and destruction of the unseen parts of my body. Sure, I started to lose weight again, slowly, but at what price?

So now, I am going back to work tonight. Nervous, only with a week recovery. Could I use more time off? Sure! Who couldn’t? But the sad truth is I can’t afford it. One week without pay was all I could do. While I adore travel nursing, and part of me wants to continue jetting around the world to exciting locals, meeting new people and seeing new places- I realize that I need to slow down and reconsider. The sad truth is I can’t “afford” to do travel nursing anymore. I need to seriously investigate a permanent position until I am finished with school. I need to get back on that bandwagon ASAP so I can finally have some viable financial options that offer nursing away from the bedside, but not in administration which I loathe with all my soul. Luckily, I love it here in St. Louis. I adore the people I work with, the unit, my boss, the hospital, the city. I am lucky I have support here and the backup to take a perm position. Hopefully that will work itself out by the end of this contract. I am still waiting to hear from HR, apparently they move glacially slow. But hopefully this will turn into something even better for me then I have had before. Meanwhile, it’s back to the grind, albeit at a little slower pace.

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To Staff, or not to Staff, That is the Question

So, when do you know if you should take a staff position or not? At what point do you decide to stop traveling? This is a question I am pondering, as my life has started to go in different directions. Travel nursing is a bit like dating- you  meet someone, go through the introductions, decide to hook up. Sometimes there is an instant click, and a honeymoon phase commences. Things seem all sunshine and roses, and then the frustrations start. You start to annoy each other. Little things bother you, until you are ready to blow up and say screw it. As an  agency nurse, you have the ability to get up and leave, that a staff position does not have. You can decline to renew your contract, or if it is just intolerable you can give notice and quit.

Other times as an agency nurse, you find yourself renewing your contract over and over. You feel connected to the place, the people, and ponder staying permanently. The thought of leaving causes anxiety. You see the flaws in the system, but you think you can change them. You think, maybe, if I work really hard and invest in this, I can make a difference. The bad boy hospital really wants to change I know it. It is suffering inside and we can make it work! So you keep renewing, and the marriage dance begins. Will they propose? will the offer be enough to accept? Should I go ahead and commit? What if it sucks? Do I really want to be committed to a sign on bonus that I have to refund if I leave?

Neither path is truly realistic. There is no “perfect hospital” or “perfect job”. No hospital administrator in shining armor on her JACHO accredited white horse to save the day. Ultimately one has to decide based on what your goals are, what you are looking for, and what needs you have. Now that I am married, and we have other things to be committed to, I am contemplating taking a staff position. Ultimately, my goal is to have a house and hopefully a baby. This requires a certain amount of permanence. Yes, there still is part of me that very much wants to just put it all in storage and travel from city to city. I would love to go to far away and exotic locations, to have hospitals talk to me with a sultry accent and woo me with new procedures and policies. To have that thrill of exploring a new city, not knowing what is around the next corner.

However, now I have someone else to consider. The truth is, its not fun traveling without your loved ones. It sucks and is very very hard. He is not in a position to travel right now, so I need to consider what will work for both of us. There are other benefits to a staff position. mainly…. benefits. As an agency nurse you can usually get at least a 401K and health insurance, though it is very expensive. The problem is the other benefits- PTO, ELB, short term disability. those are not offered as a travel nurse. If you do not work, you do not get paid. So you have to plan for time off, and save for it. That is all fine and well if everything goes according to plan, but sometimes it does not. Additionally, if I am lucky enough to get pregnant, there is no promise I can work through all of it. There are risks associated and a good chance I could end up not able to work. I need to take that into consideration.

So, at this juncture, I am contemplating my options. Continue the sexy, slightly risky path of travel nursing, or take the committed path of staff nurse. Not sure what I will do, but I will keep you all posted.

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The Freedom of Travel Nursing

I was dozing last night, when I had a random odd thought- travel nursing has freed me from the constraint of myself. How often do we get in a mode of being that caters to others expectations of who and what we should be? We get this idea of what nursing is, we go to school, we model ourselves after someone we admire, we get feedback from our managers that we are not meeting expectations but how often do we really get to be our most authentic selves?

This thought process was inspired by a talk I had with someone recently. I have been blessed to have met so many interesting awesome amazing people on my journeys. From random foursquare postings that have brought great friendships into my life, to coworkers whom I can honestly call friends. I have been exposed to all these truly wonderful characters, full of quirks and complexities.  But what has been the most astounding is the discoveries I have made about myself. I have discovered that I am, in truth, a social person. I truly like people, and I enjoy talking with them. I am in fact, a happy person. I don’t have to be weighed down by my past, or my notions about myself. Which most of the time are based on old judgements and suppositions garnered from negative experiences. It is possible to let go, and step outside of yourself when you are not constrained by “what everyone thinks” or “how it has always been”. By being a new person in a new place, it allows the freedom and space to try out different aspects of myself, that maybe I would have been too afraid to try before. I am not worried about judgment or opinions when I am traveling. I can be the real authentic me in a way that is not possible when surrounded by people who have expectations based on how I have always been. I do not need to feel self conscious, because I can approach each experience new, without fear of reprisals or condemnation. What is the worst that can happen? Someone will spank me and take my birthday away? They don’t like me? They decide I am annoying beyond all reason? The reality is nobody can make me feel badly about me, except for me.  It is truly liberating to be able to approach each new interaction without fear of rejection or results. to just be in the moment, full of possibilities, aware of my power to shape my experiences for the better. Maybe its a mid-life crisis thing, maybe because I am turning 40- I don’t know. but I am going to go with it. This is fun!

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Decisions

ok, well oddly enough I have found myself in the same place for almost a year. this means I am approaching the need to make some decisions. I like where I am, but I also need to consider everything. The main issue, is that I have opted for the tax advantage program of pay- this allows me to work for less of an hourly rate, but receive a large stipend tax free in my check each week. this helps me when I do overtime, because I do get an overtime bonus- but I don’t get knocked into the next tax bracket. when I work for straight hourly pay, a large portion goes to uncle sam.
so that being said, you can only do this for 12 consecutive months in the same location, or you have to change to the straight hourly as “non traveler”.
now, there are pluses and minuses to both. I am comfortable where I am, its close to where we are living, I like the area and I like the people I work with. the down side is the financial. the hospital corporation has its own agency it uses, and their pay rate is significantly higher, but they only offer a 401K plan, no insurance of any kind. I don’t have insurance currently, but I was going to enroll with my agency this month for that. If I convert to hourly with my agency, I will end up with a significant pay cut, at least 400 per week. that is not a good thing at all. plus any overtime will be taxed at the higher rate, which frustrates me beyond all reason.
so…basically I can either take something with my agency for 13 weeks and add an hour+ commute everyday, go out of state for 13 weeks, or change to the hospital staffing agency. the other option is to take something for 3 days a week in McAllen, and go with the local agency for 1 day a week where I am. that at least should get me 4 days per week consistently. I don’t know though. lots of things to consider.

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Update

well, I have not posted anything for a while. things have been going ok for the most part. I completed 13 weeks and renewed for 6 more. I am having some issues with my manager in my department. it is odd, because I have no problems with anyone in the facility except for her. I can say, that there is usually a reason that a place requires so many travelers. the ICU has lost a total of 14 core staff since May. this has caused so much moral problems and issues. at night we are almost all agency. there are nights I work when it is only agency working at all. there is a lot of polarization going on because of the union that has come to the hospital. it is unfortunate. I have wonderful feedback from my coworkers, from my patients and from the doctors. at this point, I am hoping to renew my contract but for the ER. I have had a great time when I have been there, and they have been very welcoming and happy to have me. it is a great opportunity to grow and get over my pediatric phobia! I love the kids, and get along well, have good patient rapport. I just am terrified of sticking needles in them! I need to get over it though.
Brownsville is lovely, and I have gone ahead and rented a house for a year here. There are so many hospitals to work in within the Rio Grande Valley, that I have lots of options. I hope things continue to go well here. so far, so good.

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Leaving Springdale

bye bye hospital

Well, another assignment down. I ended up discharging all my patients yesterday, the last one at 7:45 last night LOL. we closed the floor so I was able to be officially cancelled today. its good because it allowed me to sleep and rest last night, and finish packing today. I hope to make it to Dallas by tonight, that looks to be the halfway point. I am super excited for a road trip. I put directions in my phone on my map, and I will get to go through Oklahoma. I have every intention of singing the song and posting a video of it on facebook. 😉 it shall amuse me endlessly. my roomate is wigging out that I am so adventurous care free throw everything in a car and go- not knowing if things will be ok or not. I figure whats this compared to moving to Mexico? that was a big deal, this is just a small road trip, 14 hours. hell the drive to Mexico was a bigger deal.

I am endlessly amazed though at how awesome people are. I have met more great people that hope to stay in touch with. it is nice to know that I am capable of making friends and playing well with others 😉 I am super excited to be closer to home, and looking forward to exploring the beach there. I did have a thought I will probably be arriving just at hurricane season, which would be par for the course considering I landed in AR during tornado season! it was both appropriate and a little sad panda leaving last night, closing down the floor and winding things up. All of the people I worked with were just lovely, and even all the doctor’s were great. I had both a wonderful experience working there and being a patient! I am looking forward to going back to ICU and a lower nurse patient ratio, but it really was overall a good experience.

some new things I have learned – I must go home more often. I have been gone too long, 2 back to back assignments without going home is too much. I also learned that dayshift SUCKS. I had been doing nights for a while, and although my body likes being awake in the day better, physically dayshift kills me. its too much activity and too much traffic. I like my nightshift routine. im looking forward to returning to nights, I think I just have to make sure to have a very dark room with a easy place to sleep and I should be ok. I have learned that I really do love traveling, but it is hard without my family. I would like to explore more. a car is critical to not feeling trapped. I am not going to do anymore assignments without a car. I have also discovered that craig’s list is the bomb. I have a couple of housing options lined up already.

I also discovered it took being away from Mexico to improve my Spanish! oddly enough, it has made leaps and bounds, I think because i dont have the crutch of anyone to translate for me. I have to do it myself. I need to keep practicing, but I think there is hope I shall finally learn! well, time to hit the road before it gets any later. bye bye Arkansas, its been fun!

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Filed under Hospitals, Housing, International, Networking, Nursing, Travel Experience

car update

well the car ended up being a problem, but I was able to trade it as an even exchange for a ford taurus. the AC is not working, tried to recharge it but it must have a leak because it stopped running cold again. oh well I will be on the highway and should be ok with the windows rolled down. I swear, people change cars here more than clothes! but according to my brother in law it should be a better car.

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bought a car

well, I finally found a car. I wanted to drive to my next assignment because I have managed to collect so much crap I do not want to have to fly with it! plus I needed a car. I found a volvo 850 GLT station wagon with 117K miles for 800 bucks on craigs list. it needs a cam shaft sensor but it shouldn’t be too bad to replace. even if I spend 400 dollars on that, I am still coming out ahead, the kelly blue book value of this is 2500 bucks! I have the title and keys in hand, just need to go pick it up tomorrow morning. there is a highly recommended volvo repair dude in Fayetteville that I am going to call tomorrow and get a quote and time frame. I am also checking with my brother in law because he is a mechanic and can fix it for me, and advise if I can make it to TX without it fixed or not. I am only concerned about the time frame of getting it fixed. we turn in the rental car on Thursday and I need to leave Sat. night. I ended up on call today, unfortunately, and I was really hoping to get cancelled next Sat to give myself more time to drive. its about 14 hours and that would suck to do that all in one day. but we will see. I am just happy to know I have wheels finally. yay for craig’s list! I have a lot to do this week, I need to go to DMV and get a temporary registration thing for the car, I have 30 days to register it and I will probably make it MX anyways, so I just need the temporary paper plate thing to get to TX with. I need to go to my drug screen for my next job and get my paperwork finished up. but its all good. I am just hoping I get my ACLS cards in the mail before I am gone!

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Filed under Nursing, Regions, Transportation, Travel Experience

next location

ok, so I am very excited. I was getting concerned because I don’t have enough money saved after this assignment ends, and I cannot renew for just a few weeks like I had hoped. its complicated in that they need either a full 8 or not at all, because they have to get other people in. anyways, I was going around and around in my head with what I was going to do next, and a job has come up in Brownsville, TX! which is perfect as it is much closer to home. I can actually go home every other week! I think its all going to fall into place. it will be back on night shift again but thats ok. its an ICU there, and if I am only doing 3 days per week, I can do 6 on 8 off I am sure, and then i can actually go home! yay! its been too long away from home. and if I do some overtime some weeks, it will be ok too. but ya, its going to be for 13 weeks, but at least I can go home! I am going to take some time off in August to go see my sister, but that looks doable too. right now i am trying to figure out how I am getting there. I wish I had time to go home first, but my last day here in Springdale is July 9th, and my first day there is July 11th. so no good. but lets see. bad news its during hurricane season, so I am going from starting here with Tornadoes to starting there with hurricanes LOL. but wee another assignment down and another to start! and i will get to see people I know, and maybe even have a place to stay. one of the nurses from here is also going there, and I know people in Brownsville, so thats good. what an awesome birthday present for me!! I love my agency, I told her what I could do- either a very short assignment anywhere, or a longer one closer to home. she calls me with a job offer that day! I didn’t even have to interview, they hired me on the spot! so exciting. and very validating too LOL. I think its because people know me from there, since I did house supervisor in Laredo. I will also be able to go back and see an excellent doctor about my heart in Laredo. all in all I think this is going to be great. 🙂

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Filed under Agencies, Hospitals, Regions, Travel Experience

first couple of weeks

Ok, so I finished my first 2 weeks of my new assignment. its very different here. much harder work. I am working about 5 days a week. last week had 69 hours in total. I seem to do ok with 2 on 1 off for dayshift schedule. some days I don’t get home until late, its a very very busy unit. I manage to get rides about half the time, and cabs the other half, so I am saving money. I got cancelled today, my first day with that (I am finishing up week 3). I am considering extending 2 weeks until the end of July. my contract is up July 9th, but if I can get the overtime I might stay 2 more weeks. financially I need to do at least 4 days a week, would prefer 5. we will see how it goes. I am starting to get into the groove, that first week kicked my butt and I was asking myself what the hell I got myself into LOL,
I did come up with a good analogy though for people as to what a travel nurse is- I am the Mary Poppins of nursing. I go somewhere I am needed for a short time, then move on to another hospital that needs my help 🙂 I live out of my big carpet bag and I have some tricks, but really its about teaching people what they already knew and getting them through a bad patch. I am missing home a lot, missing my family terribly. I really need them to come and see me. I have discovered it sucks when I am off work, because I do not have a car, and I have nothing to do. anything more than 1 day off is miserable. I am bored and need stuff to do. well, we will see. its all good though.

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Filed under Hospitals, Regions, Travel Experience, Uncategorized